Gram Positive Cocci

Staphylococcus aureus
Ali Somily MD,FRCPC

Staphylococcus aureus

Staphyloccocci - derived from Greek stapyle (bunch of grapes) Gram Stain : Gram Positive Cocci Aerobic Extracellular Features
Morphology : Cocci Arrangement : Clusters Colonies: White /yellow , rounded on blood agar plate

Non motile
Non motile

No capsule No glycocalyx

Virulence Factors

Exotoxins -Lactamase
Plasmid ,Penicillin resistant

Mutant Penicillin Binding Protein (PBP)

MRSA

Coagulase
Free and bound Thrombin Fibrin

Protein A
Bind to Fc of IgG, Block complement and opsonization

Other enzymes
Lipase, Protease, Hyaluronidase, Nuclease, Fibrinolysin

Exotoxins

Hemolysins of RBCs
Alpha toxin ( septic Shock and Dermonecrosis) Beta toxin (Shingomyelinase) Delta toxin (Leukocidin) Gamma toxin (Tissue Necrosis)

Panton Valentine Leukocidin (PMNs and Micros)

Influx of Ca++,Degranulation and Lysis

Enterotoxins
Toxin A (Food Poisoning) and F (Similar to TSST)

Toxic Shock Syndrom Toxin(TSST)

Release of IL2 CD4 T-cell and IL1

Exfoliation ( Phage Group II , Epidermolytic; intraepithelial Separation at Stratum Granulosum)

Laboratory Tests

Catalase : +ve Coagulase: +ve DNase: +ve Mannitol: +ve Hemolysis: Beta 6.5 % NaCl : Growth

Source and Transmission

Colonization
Human : Nose, Skin, Groin, Other moist area Horizontal Transmission : Human contact, Sneeze and Contaminated environment Nosocomial Transmission:

Clinical Syndroms

Skin Infections (Furuncles, Boils, Carbuncles, Scalded Skin Syndrom (SSS), Burn and Wound) Food Poisoning (Enterotoxin A, No Bacteria, N&V) Toxic Shock Syndrom (Tampons, Wound, Nasal Packing) Oseomyelitis (Most Common Cause, Meta in Childern and Epiphysis in Adult, Truma or Hematogenous) Infective Artheritis (Most Common Cause in Adult) Acute Endocarditis (Most Common Cause Normal Abnormal and Prosthetic Valves ) Post viral lobar Pneumonia ( Especially Flu) Bacteremia and Sepsis (Most Common Cause ,Community Acquired) Parotitis ( Gland and Duct of Stensen)

TOXIN MEDIATED DISEASES

1. Staphylococcal food poisoning

Due to production of entero toxins heat stable entero toxin acts on gut produces severe vomiting following a very short incubation period Resolves on its own within about 24 hours

2. Toxic shock syndrome

High fever, diarrhoea, shock and erythematous skin rash which desquamate Mediated via toxic shock syndrome toxin 10% mortality rate Described in two groups of patients
Associated With young women using tampones during menstruation Described in young children and men

3. Scalded skin syndrome

Disease of young children Mediated through minor Staphylococcal infection by epidermolytic toxin producing strains Mild erythema and blistering of skin followed by shedding of sheets of epidermis Children are otherwise healthy and most eventually recover

Pustular impetigo

Hordeolumfuruncle

Bacteremiahemorrhage

Bacteremia-gangrene

Host Defense and Immunity

Opsonization (IgG, C3b or IgM +C3b) Phagocytosis (by PMNs) Cytokines (By CD4+T-Cells) No Immunity Gained by Infection

Treatment

Methicillin : Drug of Chice Penicillin : If sensitive Vancomycin: If MRSA Linazolid : If vancomycin Rsistant Cephalosporins : First Generation Bacitricin : Topical Special Situation :Rifampin ,Doxycyclin ,Trimethoprime / Sulphamethoxazole

Prevention

MRSA Infection control Isolation, Treatment , Decolonization Contact percussion

Vaccine and Toxoid : Not Available yet

Staphylococcus epidermidis

Gram Stain : Gram Positive Cocci Aerobic Extracellular Features

Morphology : Cocci Arrangement : Clusters, Tetrads Colonies: White/yellow , rounded on blood agar plate

Non motile No capsule Glycocalyx : Exopolysaccharide

Virulence Factors

Glycocalyx - Lactamase Mutant PBP

Exotoxins : None

Laboratory Tests

Catalase : +ve Coagulase: -ve DNase: -ve Mannitol: -ve Hemolysis: None Novobiocin : Susceptible

Source and Transimission

Normal Flora : Skin and Mucous membrane Infections : Trauma and Foreign bodies

Clinical

Bacteremia and Sepsis Subacte Endocarditis Neonatal Bacteremia

Host Defense and Immunity

Opsonization Phagocytosis Cytokines No Immunity Gained by Infection

Treatment

Vancomycin Cephalosporins : First generation if Sensitive

Vaccine and Toxoid : Not Available yet

Staphylococcus saprophyticus

Gram Stain : Gram Positive Cocci Aerobic Extracellular Features

Morphology : Cocci Arrangement : Clusters, Tetrads Colonies: White /yellow , rounded on blood agar plate

Non motile No capsule No Glycocalyx

Virulence Factors

Multiple Drug Resistant Hemagglutinin proteins and Surface Proteins Urease

Exotoxins : None

Laboratory Tests

Catalase : +ve Coagulase: -ve DNase: -ve Mannitol: -ve Hemolysis: None Novobiocin : Resistant

Source and Transimission

Normal Flora : of genitourinary Skin Poor Hygiene : Sexual Activity Urinary Tract

Clinical

Urinary Tract Infection (UTI)

Healthy, young, sexual active women Cystitis (Lower UTI) or Pyelonephritis (upper UTI) Pyuria : Most cases

Host Defense and Immunity

Opsonization Phagocytosis Cytokines No Immunity Gained by Infection

Treatment

Trimethoprime / Sulphamethoxazole (TMPSMZ) Ciprofluxacin : Alternative

Vaccine and Toxoid : Not Available yet